The University of Chicago

School of Social Service Administration Magazine

Volume 22 | Issue 2 | Summer 2015
Unpacking a Problem

Sometimes something as small as a letter can be one of the numerous keepsakes that trap people plagued by hoarding disorder, says Mary DeVan, AM ’72, who has a practice helping people with the problem.

DeVan, a licensed clinical social worker, views a hoarding person’s belongings as a “collage of their life.” The clutter represent their interests, passions, activities, as well as other things from their past. “Many feelings are buried in the clutter,” says DeVan, who last fall discussed her work with hoarders at the SSA Reunion Weekend in a presentation “An Overview of Hoarding Disorder.”

In order to understand the value that people attach to their belongings, DeVan asks clients to bring a few items to discuss what the items mean to them. “The therapist focuses on the feelings and not the objects,” DeVan explains.

She recalled a client who brought in a personal letter that she had saved for years and was ambivalent about discarding it. As the client read the letter out loud it was clear that a traumatic event was associated with the letter, and DeVan encouraged the client to revisit that time in her life to explore whether or not there was unfinished business that needed to be addressed.

After fully exploring her emotions associated with the letter, the client realized she no longer needed to keep the letter. She felt it was liberating to let it go, move on with her life, and deal with the rest of her clutter as well. Profound emotional issues related to traumatic events often underlie hoarding disorder.

DeVan’s interest in hoarding disorder developed because she knew people with the disorder who had wanted help, but had trouble finding resources. She became a member of the Los Angeles County Hoarding Task Force in 2002. The group includes personnel from agencies involved with hoarders such as first responders, code enforcers, health departments, and social service agencies. Hoarders’ homes can be fire and health hazards to themselves and their neighbors, as well as breeding grounds for disease-carrying pests.

DeVan established her private practice 2004 to help people take control of their lives and concentrate on behaviors that help them improve their situations.

Excessive cluttering, now called hoarding disorder, has not always been well understood and was confused with other disorders. Researchers found that people driven to save things were suffering a more specialized condition, however, and hoarding disorder was listed as its own category in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) in 2013. Hoarding disorder is characterized as the need to save things which causes significant distress or impairment in social, occupational, or other important areas of functioning. Hoarding disorder is on a continuum that can include different levels of accumulated belongings and creates unsafe situations in hoarded homes.

Even though hoarding behaviors can begin in the teen years it usually takes decades for clutter to build to the point that it becomes pathological. That is why hoarding is a problem that is seen more often with older clients. “Hoarders often spend hours trying to de-clutter. But people with this disorder are unable to categorize items, so their efforts to declutter result in ‘churning.’ Essentially the clutter is never decreased, it’s just restacked,” DeVan says.

Excessive anxiety is a clinical feature of hoarding disorder. Efforts to de-clutter can increase anxiety and cause the hoarder to stop their de-cluttering efforts. Hoarders are often ashamed and embarrassed by the condition of their home and will not allow anyone inside to provide services of any kind, resulting in both isolation and greater deterioration of conditions in the home.

Although family and friends of a hoarder may think that getting a dumpster and clearing things out is the answer, that approach can be traumatic to a hoarder and not solve the problem at all, DeVan says. “Backing up a dumpster to a hoarder’s home and cleaning it out without their permission and involvement can sever relationships temporarily and sometimes permanently,” she says. Tragically, sometimes hoarders die within six months of this kind of approach.

When DeVan talks with a client she usually begins with generalizations such as, “most people like to feel safe in their environment.” As the first step, rather than concentrating on the clutter that is impacting their lives, she encourages the hoarder to think about their safety.

This evidenced-based technique is a kind of “harm reduction model” and includes creating pathways in the home wide enough to accommodate an emergency rescue stretcher and personnel. This particular technique also works best with people who are not motivated to de-clutter but have significant safety issues that need to be corrected. Ultimately, the focus of treatment is safety, health, and overall well-being, not aesthetics of the home.

By finding a practical way to deal with hoarding, DeVan also helps people deal with the issues related to the problem, be they big ones like excessive clutter and trauma or small ones, such as a letter they couldn’t ever let go.

— William Harms